Provider Demographics
NPI:1689832511
Name:STATE OF HAWAII DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:STATE OF HAWAII DEPARTMENT OF HEALTH
Other - Org Name:CHILD AND ADOLESCENT MENTAL HEALTH DIVISION (CAMHD)
Other - Org Type:Other Name
Authorized Official - Title/Position:ACTING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:KELI
Authorized Official - Last Name:ACQUARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-733-9333
Mailing Address - Street 1:3627 KILAUEA AVE
Mailing Address - Street 2:ROOM 101
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2317
Mailing Address - Country:US
Mailing Address - Phone:808-733-9333
Mailing Address - Fax:808-733-9357
Practice Address - Street 1:3627 KILAUEA AVE
Practice Address - Street 2:ROOM 101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2317
Practice Address - Country:US
Practice Address - Phone:808-733-9333
Practice Address - Fax:808-733-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health